title: Pseudopathologic vertebral body enhancement in the presence of superior vena cava obstruction on computed tomography.
abstract: BACKGROUND
  Superior vena cava (SVC) obstruction can cause the development of collateral vessels. During contrast-enhanced thoracic computed tomography (CT), contrast material may reflux into the collaterals such as paravertebral venous plexus. However, an unusual pseudopathologic vertebral body enhancement on CT in the presence of SVC obstruction has not been studied previously.
  
  
  OBJECTIVE
  To demonstrate clinical presentation and imaging findings of pseudopathologic vertebral body enhancement in patients with SVC obstruction.
  
  
  METHODS
  Retrospective study of diagnostic CT images examined at our clinic.
  
  
  METHODS
  From March, 2009 to September, 2012, a retrospective radiologic database review was performed to identify patients with obstruction of SVC causing contrast reflux into collateral vessels and presented with an unusual vertebral body enhancement on thoracic CT. Thirteen patients (11 men, mean age 51.4 years) with vertebral body enhancement were enrolled.
  
  
  METHODS
  Enhancement patterns of vertebral bodies were classified as nodular enhancement with round shape occupying less than one-third of vertebral body or polygonal enhancement occupying greater than or equal to one-third of vertebral body on axial image. The locations of enhanced areas within vertebral bodies were described using right lateral/central/left lateral, anterior/posterior, and upper/middle/lower in the x-, y-, or z-axis directions, respectively.
  
  
  METHODS
  Enhancement patterns, locations, and the presence of a connection between vertebral body enhancement and the paravertebral venous plexus were evaluated.
  
  
  RESULTS
  A total of 39 vertebral body enhancements were found in the 13 patients, involving cervical (n=12), thoracic (n=25), or lumbar (n=2) vertebrae. Vertebral body enhancements showed a nodular (n=19) or a polygonal (n=20) pattern. The central portions of vertebral bodies were more frequently involved. The connection to the paravertebral venous plexus was observed in 34 lesions (87.2%).
  
  
  CONCLUSIONS
  Patients with SVC obstruction with extensive collateral vessels might exhibit a pseudopathologic vertebral enhancement. They tended to involve the central portion of the vertebral body, and most of them showed connection to the paravertebral venous plexus.
authors.affiliation: Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea. Electronic address: yonmi.sung@gmail.com.
authors.forename: Yon Mi
authors.initials: YM
authors.lastname: Sung
authors.affiliation: Department of Nuclear Medicine, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
authors.forename: Kyung Hoon
authors.initials: KH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.affiliation: Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging*; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Collateral circulation; Computed tomography; Superior vena cava; Thorax; Vertebra